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At least 1,045 records · Page 58Linked to original sources
PubMed1985

Assessment of morbidity and mortality in primary cytoreductive surgery for advanced ovarian carcinoma.

Even with wider application of cytoreductive surgery for advanced ovarian cancer, there is still a lack of adequate documentation concerning morbidity and mortality associated with this surgery. The purpose of this paper is to provide such information. This report is based on a retrospective analysis of 60 patients with Stage III and IV disease who had maximal cytoreductive surgery at the Long Island Jewish-Hillside Medical Center between January 1975 and February 1982. This analysis was focused on variables related to morbidity and mortality associated with the procedure. The results indicated that operating time, blood loss, intraoperative and postoperative complications, postoperative morbidity, and the length of hospital stay were acceptable. Only one operative mortality was encountered. The presence of a gynecologic oncologist in the operating room was crucial in carrying out optimal cytoreductive surgery. It is concluded that morbidity and mortality in primary maximal cytoreductive surgery for advanced ovarian carcinoma are acceptable and the surgery should be performed if feasible.

Castration↗
PubMed1989

"Nongynecologic" surgical procedures performed on a gynecologic oncology service.

One thousand fifty-eight patients had major surgery in a community-based, university-affiliated gynecologic oncology service. Of these, 233 underwent a total of 275 "nongynecologic" surgical procedures. Two hundred twenty patients suffered from gynecologic malignancies, whereas 13 had surgery for benign disorders. Eighty-two procedures were performed on the gastrointestinal tract, 44 on the urinary tract, and 149 on extrapelvic lymph nodes. Except for ovarian carcinoma and benign conditions the majority of gastrointestinal or urinary tract operations were preceded by radiation therapy. When the nongynecologic operation was necessitated at a time subsequent to initial therapy of the malignancy, a high incidence of recurrent disease was discovered. Of the 275 procedures, reoperation because of early or late complications was necessary in only 8 instances. Only one postoperative death was caused by complications of surgery. Other mild postoperative complications were transient and responded to routine noninvasive care. The complication rate and morbidity of nongynecologic surgical procedures performed on a gynecologic oncology service are low and should encourage gynecologic oncologists to continue their present comprehensive approach to patient care.

Combined Modality Therapy↗
PubMed1989

Rectal J pouch reservoir to decrease the frequency of tenesmus and defecation in low coloproctostomy.

Low anterior resection of the colon with very low coloproctostomy is a procedure occasionally required in the surgical management of the patient with gynecologic malignancy. Very low end-to-end anastomosis of the colon to rectum has been associated with fecal frequency and tenesmus in up to 70% of cases. The construction of a rectal J-pouch low-pressure reservoir has been reported to have a salutary effect upon these symptoms. Between March 1987 and January 1988 a pilot study was carried out in which six patients with primary or recurrent gynecologic malignancy who underwent low anterior resection of the colon requiring very low coloproctostomy (below 6 cm) had construction of a rectal J-pouch reservoir with a Strasbourg-Baker end-to-side coloproctostomy. No postoperative complications were noted in this small series of patients. No patient has had more than three stools per day since surgery. Antidiarrheal medication was not required. All patients denied tenesmus. It was concluded that the rectal J-pouch reservoir offered a surgical technique for avoiding tenesmus and fecal frequency in very low end-to-end anastomosis of colon to rectum.

Anastomosis, Surgical↗
PubMed1990

Inability of polyglycolic acid mesh to inhibit immediate post-radical pelvic surgery adhesions.

The ability of a polyglycolic acid (PGA)-derived mesh to limit the formation of immediate postoperative pelvic adhesions after radical resection of the pelvic viscera and peritoneum was investigated. Twenty female canines underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, and infracolonic omentectomy. The entire peritoneum of the pelvis and lower abdomen also was removed. In ten animals, a single layer of PGA mesh, tailored to cover the deperitonealized area, was sutured in place. Reperitonealization was not performed in control animals. Four weeks after initial surgery, animals were reexplored and killed. Adhesions to the anterior abdominal wall and pelvis were quantified and graded: (Table: See Text) These data indicate that the placement of a PGA mesh induces significant pelvic adhesions and potentiates the formation of pelvic abscesses.

Animals↗
PubMed1990

Distally based rectus abdominis flap for reconstruction in radical gynecologic procedures.

The distally based rectus abdominis myocutaneous flap is an important adjunct to radical pelvic surgery. It can be used to fashion a functional neovagina or to create a patch to cover perineal defects created by exenterative surgery. This report reviews the technical aspects of the creation of this flap and our experience with 22 patients who have undergone this procedure. The flap has been found to be technically easy to create. It is reliable with little tissue loss, and donor site complications are acceptable. Healing is aided by filling the pelvic dead space, thereby decreasing bowel complications, and by bringing a new blood supply into the operative site which has often been heavily irradiated. Operative time is minimized since the procedure requires only unilateral mobilization. Subsequent abdominal surgery has been performed without fascial complications.

Abdominal Muscles↗
PubMed1990

Cancer of the cervix.

Since the introduction of the Papanicolaou smear and colposcopy, cervical cancers can be diagnosed and treated easily in their preinvasive state. Although theoretically cancer of the cervix should be detected and treated before becoming invasive disease, there are still too many women who develop invasive cancer of the cervix and require radical surgery and/or radiation therapy. The management of patients with recurrent or advanced disease is difficult and challenging.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2005

The use of tissue flaps as an adjunct to pelvic surgery.

BACKGROUND: The clinical problems of advanced malignancy with invasion of cancers into adjacent organs or structures, fistulizing complications from radiation therapy, postoperative infections, and delayed postoperative healing continue to challenge pelvic surgeons, regardless of subspecialty. The use of autologous muscle and myocutaneous flaps has been applied to the management and prevention of these clinical problems and found to be most helpful. METHODS: Records of patients undergoing abdominopelvic procedures in a single unit during the 15-year period from 1990 to 2005 were reviewed, and patients undergoing autologous tissue flaps were reviewed with respect to indications, complications, and outcomes. RESULTS: Thirty-four patients underwent 35 autologous muscle or myocutaneous flaps for the following indications: large anticipated defects in primary or reoperative cancer surgery (13 patients); malignant, traumatic, inflammatory, or radiation-induced fistulae (12 patients); excision of (an) adjacent organ(s) with need for reconstruction (7 patients); and chronic nonhealing pelvic wounds (2 patients). Wound complications occurred in 41% of patients; however, primary healing of flaps occurred in 88% of patients. CONCLUSIONS: The use of autologous tissue flaps in select patients can be a useful adjunct in pelvic surgery in dealing with a wide variety of problems, specifically in filling large defects, providing vascularized tissue for fistula closure, and avoiding delayed wound healing commonly seen after high-dose radiation.

Cohort Studies↗
PubMed2006

[Vaginal reconstruction after anterior pelvectomy by deep inferior epigastric perforator flap (DIEP)].

Muscle sparing technique is one of the latest improvements of rectus abdominis flaps harvesting. It minimizes donor site morbidity by preserving the abdominal wall. The deep inferior epigastric perforator flap (DIEP) provides reliable tissues for vaginal reconstruction with local low morbidity. We describe the surgical technique and flap-related specific complications. This technique is safe and useful in the vaginal reconstruction especially following a radiotherapy.

Abdominal Wall↗
PubMed2006

The addition of extensive upper abdominal surgery to achieve optimal cytoreduction improves survival in patients with stages IIIC-IV epithelial ovarian cancer.

OBJECTIVES: To determine the survival impact of adding extensive upper abdominal surgical cytoreduction to standard surgical techniques for advanced ovarian cancer. METHODS: The records of all patients with stages IIIC-IV epithelial ovarian cancer who underwent primary surgery at our institution from 1998 to 2003 were reviewed. The cohort was divided into 3 groups. Group 1 patients required extensive upper abdominal surgery, such as diaphragm peritonectomy/resection, resection of parenchymal liver or porta hepatis disease and/or splenectomy with or without distal pancreatectomy, to achieve optimal cytoreduction (residual disease<or=1 cm). Group 2 patients were optimally cytoreduced by standard surgical techniques, including hysterectomy, oophorectomy, omentectomy, and bowel resection. Group 3 patients were suboptimally cytoreduced. Primary outcome measures were response to primary chemotherapy, progression-free survival, and overall survival. RESULTS: The cohort of 262 patients was divided as follows: Group 1, 57 patients; Group 2, 122 patients; and Group 3, 83 patients. The median follow-up was 36 months (range, 1-94 months). Frequency of clinical complete response in Groups 1, 2, and 3 was 82%, 78%, and 57%, respectively. The median progression-free survival for Groups 1, 2, and 3 was 24, 23, and 11 months, respectively. Progression-free survival for Groups 1 and 2 were equivalent (P=0.53) and were significantly longer than for Group 3 (P<0.001). The median overall survival was 84 and 38 months for Groups 2 and 3, respectively, and had not been reached for Group 1 by 68 months. Patients in Group 1 had equivalent overall survival to patients in Group 2 (P=0.74) and improved survival over patients in Group 3 (P<0.001). Prognostic factors significant on multivariate analysis included stage, optimal status, and ascites. CONCLUSIONS: Patients requiring extensive upper abdominal procedures to achieve optimal cytoreduction demonstrated a similar initial response, progression-free survival, and overall survival to patients optimally cytoreduced by standard surgical techniques. The presence of bulky upper abdominal disease alone did not appear to indicate poor tumor biology. This initial maximal surgical effort was associated with improved survival in patients who would have otherwise been suboptimally cytoreduced.

Adult↗